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Neurology > Headache > Flashcards

Flashcards in Headache Deck (60):
1

what is the exam usually like in headache

normal
expect in tumours

2

name the ha:
visual disturbance, sub acute onset headache, dark rooms make it better

migraine

3

name the ha:
Headache every time you stood up and fine when you sat down

low ICP

4

name the ha:
Every time you lie down heachache and when stand up fine, wakes you up in morning

high ICP

5

name the ha:
Make, smoker, one sided headache v sore that lasts half an hour

cluster ha

6

name the ha:
non specific, pain 2 on scale

stress ha

7

what are the associated factors you should ask about

Autonomic features (N+V), photophobia, phonophobia, positive visual symptoms, ptosis, miosis, nasal stuffiness

8

what are the ha exacerbating factor you should ask about

Posture, valsalva (sneezing, coughing, straining etc). Diurnal variation.

9

who does a migraine most commonly affect

young females

worse in teenage years/ early 20s then worse again in 40s/50s

10

what are the red flags for headaches

new onset >55
known/ previous malignancy
immunosuppressed (worry about intracranial infection)
early morning ha
exacerbated by valsalva (coughing, sneezing= raised ICP)

11

what past medical history is important in has

previous cancer
predisposition to thrombosis

12

why is social history important in ha

as problems can manifest as pain

13

how often do people usually get migrinaes

once a month

14

what are the diagnostic (IHS criteria) features for a migraine without aura

at least 5 attacks
lasts 4-72 hours

2 of:
-moderate/ severe, unilateral, throbbing pain, worse on movement

1 of:
-autonomic features, photo/phono phobia

15

when is migraine pain worse

evolves from on set, not worse at start
reaches 6/7 out of 10 pain

16

what is the pathophysiology of a migraine

both vascular and neural influences
have to be susceptible patient
stress trigger changes in brain- release of serotonin
blood vessels constrict and dilate
chemical including substance P irritate nerves and blood vessels causing pain

17

what is the pathophysiology of a migraine with aura

-cortical spreading depolarisation
-activation trigeminal vascular system - dilation of cranial blood vessels
-release of substance P, neurokinin A, CGRP

18

where is the migraine centre

dorsal raphe nucleus and the locus coeruleus

19

how many migraines have an aura

20%

20

what is an 'aura'

fully reversible visual, sensory, motor or language symtoms

visual most common

21

what language symptoms can you get with migraine

speech problems
word finding difficulties

22

how long does an aura usually last

20-60 mins, headache follows < 1 hour later (but can occur simultaneously)

23

what types of visual aura can you get

central scotomata
central fortification
hemianopic loss

24

what are the migraine tiggers

sleep
dietary (chocolate, cheese, alcohol)
stress
hormonal (menstrual)
physical exertion

(ha diary helpful to identify)

25

what are the non pharmological treatments for migraines

education- avoid triggers
ha diary
relaxation/ stress management
healthy diet
hydration
reduce caffeine
exercise

26

what are the acute/ abortive pharmalogical treatments for migraines

NSAID:
-aspirin 900mg,
-naproxen 250mg,
-ibruprofen
+/- anti emetic if gastroparesis
take asap

Triptans
-5HT agonist (Rizatriptan= eletriptan > sumatriptan)
Oral, sub-lingual, subcutaneous- consider method of administration in those with N+V
treat at start of headache
similar efficacy to NSAIDS

27

what are the prophylaxic treatments for migraines

amitriptyline (10-25mg)
propanalol (80-240mg)
topiramate (25-100mg)

titrate drug as tolerated to achieve efficacy at the lowest dose possible
Must trial each for minimum of 3 months
Consider non-pharmacological methods such as acupuncture, relaxation exercises

others inc- gabapentin, pizotifen, Na valporate, botox (given if 3 failed medicines), monoclonal antibodies

28

when do you gove migraine prophylaxs

3 attacks per month or if very severe

29

what are the side effecrts of amitriptyline

dry mouth
postural hypotension
sedation
light headedness

30

who do you not give a beta blocker to

asthmatics, PVD, heart failure

31

what is topiramate and what are its side effects

carbonic anhydrase inhibitor

nasty drug
weight loss, paraesthesia, impaired concentration, enzyme inducer, probably teratogenic

32

what are the rarer types of migraine

acephalgic- aura
basilar- vertigo,, get unsteady
retinal
ophthalmic
hemiplegic (familial/ sporadic)- get symptoms similar to stroke, encephalopathic
abdominal- children, recurrent abdo pain

33

is migraine unilateral or bilateral

unilateral

34

what are the features of a tension headache

can be episodic or chronic
pressing tingling sensation
bilateral
mild to moderate pain
absence of N&V
absence of photophobia or phonophobia

35

what is the treatment for tension type headaches

relaxation physio
antidepressant
-dothiepin or amitriptyline
-3 month review

reassure

36

what causes tension headaches

often stressors

37

what are the trigeminal autonomic cephalgias (TACs)

a group of primary headache disorders characterised by unilateral trigeminal distribution pain that occurs in association with prominent ipsilateral cranial autonomic features

(is a primary headache complex)

38

what is a primary headache

one not caused by a tumour

39

what are the ispilateral autonomic features seen in trigeminal autonomic cephalgias

ptosis
miosis
nasal stuffiness
N/V
tearing
eye lid oedema

40

what are the four main types of trigeminal autonomic cephalgias

cluster
paroxsymal hemicrania
hemicrania continua
SUNCT (short lived unilateral neuralgiaform headache, conjunctival injections, tearing)

41

who gets cluster has

young (30-40s)
men> women

42

what are the features of a cluster ha

circadian (around sleep) and seasonal variation
severe unilateral headache
lasts 45-90 mins
get 1-8 a day
cluster bout may last few weeks to months
severe pain, dont like to lie still

43

what is the treatment for a cluster ha

high for oxygen 100% for 20 mins (home canisters)
sub cut sumatriptan 6mg
steriods (reducing course over 2 weeks)
verapamil for prophylaxis

(all have MRI to make sure nothing there)

44

who gets paroxysmal hemicrania

older (50s-60s)
women> m3n

45

what are the features of paroxysmal hemicrania

severe unilateral headache
unilateral autonomic features
lasts 10-30 mins
1-40 a day

(shorter duration and more frequent than cluster has)

46

what is the treatment for paroxysmal hemicrania

responds v well to indomethicin (used to diagnose)

47

what is SUNCT

short lived (15-120 seconds)
unilateral
neuralgiaform headache
conjunctival injections
tearing

48

what is the treatment for SUNCT

lamotrigine
gabapentin

49

what investigations for those with new onset unilateral cranial autonomic features

always do MRI brain and MR angiogram

50

who gets idiopathic intracranial hypertension

F>m
obese

51

what are the symptoms of idiopathic intracranial hypertension

headache (diurnal variation, worse when they wake up, morning N&V)
visual loss- enlarged blind spot

52

what investigations do you do into idiopathic intracranial hypertension

MRI with MRV sequence (should be normal)
cerebrol spinal fluid (elevated pressure, normal constituents)
visual fields

53

when is the only time you do a lumbar puncture in raised ICP

IIH- do scan of brain first to make sure its normal

54

what is the treatment for IIH

weight loss
acetazolamide
ventricular atrial/ lumbar peritoneal shunt (only if patient going blind as
problematic)
monitor visual fields and CSF pressure

55

who gets trigeminal neuralgia

elderly (>60)
women> men

56

what are the features of trigeminal neuralgia

triggered by touch, usually V2/3
severe stabbing unilateral pain
duration 1-90 seconds
10 to 100 times a day
bouts of pain may last weeks to months before remission
chewing makes it worse

57

what is the treatment for trigeminal neuralgia

carbamazepine
gabapentin
phenytoin
baclofen

surgically:
-abalation
-decompression

58

what investigations in trigeminal neuralgia

MRI brain

59

what other than trigeminal neuralgia should you consider in facial pain

eyes, ears, sinuses, teeth, TMJ etc

60

what is the 1st line for uncomplicated migraines

symptomatic NSAIDs